Culture Shock: Dallas Ebola Case a Distraction

The real action is in West Africa where thousands are dying.

by Michael Smith Michael Smith North American Correspondent, MedPage Today
October 04, 2014

Lost in all the brouhaha about the Dallas Ebola case is one salient fact:

Thomas Eric Duncan, now reportedly in serious condition in Texas Health Presbyterian Hospital, didn't catch the virus in the U.S. He caught it some 5,700 miles away in Liberia.

That's where the Ebola action is. That's where thousands are ill and dying. That's where our attention should be focused, not a sideshow half a world away.

I don't mean to minimize Duncan's illness, nor the risks faced by people he was in contact with while his symptoms appeared and grew.

Duncan faces a difficult battle, but he's in a pretty good place to fight it -- a tertiary care hospital in the U.S. of A. The goal is to keep him alive until his immune system kicks the virus, and if it can be done anywhere, it can be done there.

Family members, friends, and healthcare workers who were in contact with him also face an uncertain time, as they wait to see if they have been infected with what is, after all, a scary virus.

So our sympathy and support should be with them.

But.

The World Health Organization released its latest case counts on the West Africa epidemic: in the three nations at the center of it -- Guinea, Sierra Leone, and Liberia -- the agency has recorded 7,470 cases and 3,431 deaths.

In Liberia alone, the numbers are 3,834 and 2,069, respectively.

The numbers, the WHO admits, are almost certainly a vast underestimate.

If the epidemic had been contained -- as it could have been with quicker international action -- there would be no need to worry about people bringing Ebola to the U.S.

Conversely, if the epidemic is not contained -- as it still might not be unless the international community gets cracking -- we will get more such cases.

There's some evidence that Duncan lied on a form he had to fill out to leave the country, denying that he had been in contact with Ebola patients when in fact he had been.

That's not surprising, really. His motives could have been benign (lie on the form and I get to see the family) or not (lie on the form and if I do get sick, I can at least get treatment).

But as the numbers rise in Liberia, Guinea, and Sierra Leone, we can expect to see more people trying increasingly desperate expedients to get out. Some, presumably, will be infected and some of those will slip through whatever protective net we string up.

The public health networks are simply orders of magnitude better than those in Africa, and remember -- Ebola is a tough disease to catch. You need to somehow get infected body fluids into your body and that means close contact with an infected person or someone who has died of the disease.

As in Dallas, people arriving with Ebola would very quickly be isolated in tertiary care hospitals and all of their contacts closely monitored (and isolated in turn if needed).

They wouldn't be hiding and dying in secret, as they are in West Africa, and often infecting those who care for them. Doctors and nurses would be well-protected, as they are not in West Africa.

And a primary source of new infections -- the practice of gathering in family groups to wash and clean the body of a dead loved one -- simply doesn't happen here.

So we need to calm down and keep our eyes on the prize. The main theater of this war is in West Africa; stopping Ebola there means stopping it here. Let's not be distracted -- for more than a couple of news cycles, anyway -- by what is essentially a skirmish 5,700 miles from the action.

Culture Shock is a blog by Michael Smith for readers with an interest in infectious diseases.

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